Background: Genu varum results in an abnormal mechanical stress that might potentially contribute to premature deterioration of the knee joint. Hence, it is important to correct the malformation to avert the occurrence of arthritis, which leads to impaired functionality. Objectives: This work aimed to assess the clinical, radiological results and the complications in gradual correction of severe Genu varum greater than 20 degrees using Ilizarov fixator. Patients & methods: This interventional study included 20 cases of genu varum greater than 20 degrees, which underwent gradual correction using the Ilizarov fixator at Menoufia University Hospital. Results: There was a highly statistically significant variance between the pre-operative and post-operative measurements regarding range of motion, flexion deformity, mechanical axis deviation (MAD-C), joint congruence angle (JCA), proximal medial tibial angle (mMPTA), and total HSS knee score. However, no statistically significant differences were found regarding the mechanical lateral distal femoral angle (mLDFA), posterior proximal tibial angle (PPTA), and tibial slope (°). The number of cases with compartment syndrome in the study population was 2 (10%), while the number of cases with insufficient callus formation was 1 (5%). Conclusion: Gradual correction using the Ilizarov fixator is a safe, accurate, and reliable method for correcting severe genu varum greater than 20 degrees. Clinically, the total HSS knee score, including pain, function, range of motion, muscle strength, flexion deformity, and instability, significantly improved postoperatively. Radiologically, mMPTA, MAD-C, ICA, and TFA significantly increase after surgery, without disturbing the posterior tibial slope.